Functional thoracic hyperkyphosis model for chronic subacromial impingement syndrome: An insight on evidence based "Treat the Cause" concept - A case study and literature review
ABSTRACT Recent evidences suggest functional thoracic hyperkyphosis (FTH) could be a different approach in the management of subacromial impingement syndrome (SIS). This case study aims firstly with the development of evidence informed FTH model for SIS. Secondly this study aimed to develop well defined multimodal physical therapy intervention for FTH and its related mechanical consequences in elderly patient with chronic SIS. As a result, Level IV positive evidence was found in both the short and long-term pain and disability of chronic SIS, using FTH model with 26 months of follow-up.
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ABSTRACT: To examine the accuracy of clinical tests for diagnosing subacromial impingement syndrome (SIS). A systematic literature search was conducted in January 2011 to identify all studies that examined the diagnostic accuracy of clinical tests for SIS. The following search engines were used: Cochrane Library, EMBASE, Science Direct, and PubMed. Two reviewers screened all articles. We included prospective or retrospective cohort studies that examined individuals with a painful shoulder, reported any clinical test for SIS, and used arthroscopy or open surgery as the reference standard. The search strategy yielded 1338 articles of which 1307 publications were excluded based on title/abstract. Sixteen of the remaining 31 articles were included. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were followed to conduct this review. The number of true positives, false positives, true negatives, and false negatives for each clinical test were extracted from relevant studies, and a 2×2 table was constructed. Studies were combined using a bivariate random-effects model. Heterogeneity was assessed using the variance of logit-transformed sensitivity and specificity. Ten studies with 1684 patients are included in the meta-analysis. The Hawkins-Kennedy test, Neer's sign, and empty can test are shown to be more useful for ruling out rather than ruling in SIS, with greater pooled sensitivity estimates (range, .69-.78) than specificity (range, .57-.62). A negative Neer's sign reduces the probability of SIS from 45% to 14%. The drop arm test and lift-off test have higher pooled specificities (range, .92-.97) than sensitivities (range, .21-.42), indicating that they are more useful for ruling in SIS if the test is positive. This systematic review quantifies the diagnostic accuracy of 5 clinical tests for SIS, in particular the lift-off test. Accurate diagnosis of SIS in clinical practice may serve to improve appropriate treatment and management of individuals with shoulder complaints.Archives of physical medicine and rehabilitation 02/2012; 93(2):229-36. DOI:10.1016/j.apmr.2011.08.035 · 2.44 Impact Factor
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ABSTRACT: The study investigated the effectiveness of stretching, strengthening exercises, and the scapular stabilization exercises on the pain, shoulder range of motion (ROM), muscle strength, joint position sense (JPS), scapular dyskinesis and quality of life (OL) in the patients with subacromial impingement syndrome (SIS). 27 women and 13 men, mean age 51 (24-71) years old, were included in this study. All the patients were separated into 2 groups according to simple random table. Stretching and strengthening exercises were given to the group I (n=20) and scapular stabilization exercises were added to the group II (n=20). The pain severity, shoulder ROM, muscle strength, JPS, lateral scapular slide test (LSST), Western Ontario Rotator Cuff (WORC) Index were evaluated before and after treatment. Patients completed a 6-week rehabilitation program, three times a week. The results showed that all measurements improved statistically in both groups after treatment (p < 0.05). And the improvements in the muscle strength, JPS and scapular dyskinesia were significantly different in group II (p < 0.05). It is suggested that in the treatment of SIS; scapular stabilization exercises, given with stretching and strengthening exercises, can be more effective in increasing the muscle strength, developing the JPS and decreasing the scapular dyskinesis.Journal of Back and Musculoskeletal Rehabilitation 01/2011; 24(3):173-9. DOI:10.3233/BMR-2011-0291 · 1.04 Impact Factor
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ABSTRACT: The purpose of this study was to develop a short, reliable, and valid measure of physical function and symptoms related to upper-limb musculoskeletal disorders by shortening the full, thirty-item DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure. Three item-reduction techniques were used on the cross-sectional field-testing data derived from a study of 407 patients with various upper-limb conditions. These techniques were the concept-retention method, the equidiscriminative item-total correlation, and the item response theory (Rasch modeling). Three eleven-item scales were created. Data from a longitudinal cohort study in which the DASH questionnaire was administered to 200 patients with shoulder and wrist/hand disorders were then used to assess the reliability (Cronbach alpha and test-retest reliability) and validity (cross-sectional and longitudinal construct) of the three scales. Results were compared with those derived with the full DASH. The three versions were comparable with regard to their measurement properties. All had a Cronbach alpha of > or = 0.92 and an intraclass correlation coefficient of > or = 0.94. Evidence of construct validity was established (r > or = 0.64 with single-item indices of pain and function). The concept-retention method, the most subjective of the approaches to item reduction, ranked highest in terms of its similarity to the original DASH. The concept-retention version is named the QuickDASH. It contains eleven items and is similar with regard to scores and properties to the full DASH. A comparison of item-reduction approaches suggested that the retention of clinically sensible and important content produced a comparable, if not slightly better, instrument than did more statistically driven approaches.The Journal of Bone and Joint Surgery 05/2005; 87(5):1038-46. DOI:10.2106/JBJS.D.02060 · 4.31 Impact Factor